Publications by authors named "Giovanni Cammaroto"

70 Publications

Barbed reposition pharyngoplasty (BRP) in obstructive sleep apnea treatment: State of the art.

Am J Otolaryngol 2021 Sep 1;43(1):103197. Epub 2021 Sep 1.

Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy; Department ENT & Audiology, University of Ferrara, Ferrara, Italy.

Purpose: In this paper, we perform a systematic review that discusses the state of the art and evolution on the barbed reposition pharyngoplasty (BRP) in the velo-pharyngeal surgery. Clinical evidence and published outcomes of this surgical technique are reported and discussed.

Materials And Methods: We performed a systematic review of the current literature through the analysis of the last 10 years of literature on barbed palate surgery. Study design, number of patients enrolled, inclusion criteria, pre- and posttreatment outcomes (AHI, ODI), surgical success rate, follow-up time and complication has been collected and reported.

Results: 15 studies for a total of 1531 patients, out of which 1061 underwent barbed reposition pharyngoplasty. Five trials were uncontrolled prospective studies (215 patients, 14% of total), nine were retrospective studies (1266 patients, 82,6% of total), and one randomized prospective clinical trial (RCT) (50 patients, 3,32% of total). All analyzed studies reported good outcomes after BRP surgery. Average preoperative values of AHI and ODI reduced in all studies considered with a significative statistical difference between preoperative and postoperative values (p < 0.05 in all cases). The postoperative surgical success rate ranged between 65.4 and 93% of cases. There were no significant intra-operative or post-operative complications in all studies considered in this systematic review.

Conclusions: Barbed reposition pharyngoplasty has proven to be an easy to learn, quick, safe and effective new palatopharyngeal procedure, that can be used in a single level surgery or as a part of multilevel procedures.
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http://dx.doi.org/10.1016/j.amjoto.2021.103197DOI Listing
September 2021

OSA Upper Airways Surgery: A Targeted Approach.

Medicina (Kaunas) 2021 Jul 6;57(7). Epub 2021 Jul 6.

Ear Nose Throat (ENT) Unit, Head & Neck Department, Morgagni-Pierantoni Hospital, Romagna Health Service, 47121 Forlì, Italy.

Obstructive sleep apnea syndrome (OSA) is a multi-factorial disorder, with quite complex endotypes, consisting of anatomical and non-anatomical pathophysiological factors. Continuous positive airway pressure (CPAP) is recognized as the first-line standard treatment for OSA, whereas upper airway (UA) surgery is often recommended for treating OSA patients who have refused or cannot tolerate CPAP. The main results achievable by the surgery are UA expansion, and/or stabilization, and/or removal of the obstructive tissue to different UA levels. The site and pattern of UA collapse identification is of upmost importance in selecting the customized surgical procedure to perform, as well as the identification of the relation between anatomical and non-anatomical factors in each patient. Medical history, sleep studies, clinical examination, UA endoscopy in awake and drug-induced sedation, and imaging help the otorhinolaryngologist in selecting the surgical candidate, identifying OSA patients with mild UA collapsibility or tissue UA obstruction, which allow achievement of the best surgical outcomes. Literature data reported that the latest palatal surgical procedures, such as expansion sphincter palatoplasty or barbed reposition palatoplasty, which achieve soft palatal and lateral pharyngeal wall remodeling and stiffening, improved the Apnea Hypopnea Index, but the outcome analyses are still limited by methodological bias and the limited number of patients' in each study. Otherwise, the latest literature data have also demonstrated the role of UA surgery in the improvement of non-anatomical factors, confirming that a multidisciplinary and multimodality diagnostic and therapeutical approach to OSA patients could allow the best selection of customized treatment options and outcomes.
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http://dx.doi.org/10.3390/medicina57070690DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8305825PMC
July 2021

Association Between Severity of COVID-19 Respiratory Disease and Risk of Obstructive Sleep Apnea.

Ear Nose Throat J 2021 Jul 28:1455613211029783. Epub 2021 Jul 28.

Intensive Care Unit, Morgagni-Pierantoni Hospital, AUSL of Romagna, Forlì, Italy.

Objectives: The purpose of this observational retrospective study was to evaluate, in patients with a severe acute respiratory syndrome coronavirus 2 infection, the association between the severity of coronavirus disease 2019 (COVID-19) respiratory illness and the risk of infected patients to develop obstructive sleep apnea (OSA).

Methods: Ninety-six patients with confirmed COVID-19 infection were enrolled in the study. The STOP-BANG questionnaire to investigate the risk of the OSA syndrome was filled in by the patients at admission. The enrolled patients were divided into 2 groups according to the respiratory disease: group 1 (72 patients), hospitalized patients undergoing conventional oxygen therapy; group 2 (24 patients), patients requiring enhanced respiratory support. STOP-BANG results of these 2 groups were compared to observe whether patients with high OSA risk more frequently presented a severe form of COVID-19.

Results: 41.6% of the patients in group 2 had a STOP-BANG score between 5 and 8 (high risk of having apnea); in contrast, 20.8% of the patients in group 1 had a STOP-BANG score between 5 and 8, with a statistically significant difference between the 2 groups ( = .05). A complementary trend was observed regarding the proportion of patients in the range 0 to 2, which classifies patients at a low risk of OSA (48.6% vs 20.8% for groups 1 and 2, = .01).

Conclusions: According to our data, the chances of having a severe case of COVID-19 should be considered in patients at high risk of OSA.

Current Knowledge/study Rationale: Emerging research suggests that OSA could represent a potentially important risk factor for the severe forms of COVID-19. The purpose of this observational retrospective study was to evaluate the potential association between OSA and the severity of COVID-19 disease.

Study Impact: According to our data, the likelihood of contracting a severe form of COVID-19 disease should be considered in patients at high risk of OSA.
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http://dx.doi.org/10.1177/01455613211029783DOI Listing
July 2021

Impact of COVID-19 pandemic on the incidence of otitis media with effusion in adults and children: a multicenter study.

Eur Arch Otorhinolaryngol 2021 Jul 4. Epub 2021 Jul 4.

Otolaryngology, Head-Neck and Oral Surgery Unit, Department of Head-Neck Surgery, Morgagni Pierantoni Hospital, Via Carlo Forlanini, 34, 47121, Forli, Italy.

Purpose: To compare and analyze the incidence of otitis media with effusion (OME), before and during the COVID-19-related pandemic period, to evaluate the effects of the social changes (lockdown, continuous use of facial masks, social distancing, reduction of social activities) in the OME incidence in children and adults.

Methods: The number of diagnosed OME in e five referral centers, between 1 March 2018 and 1 March 2021, has been reviewed and collected. To estimate the reduction of OME incidence in children and adults during the COVID-19 pandemic period the OME incidence in three period of time were evaluated and compared: group 1-patients with OME diagnosis achieved between 1/03/2018 and 01/03/2019 (not pandemic period). Group 2-patients with OME diagnosis achieved between 1/03/2019 and 1/03/2020 (not pandemic period). Group 3-patients with OME diagnosis achieved between 1/03/2020 and 1/03/2021 (COVID-19 pandemic period).

Results: In the non-pandemic periods (group 1 and 2), the incidence of OME in the five referral centers considered was similar, with 482 and 555 diagnosed cases, respectively. In contrast, the OME incidence in the same centers, during the pandemic period (group 3) was clearly reduced with a lower total number of 177 cases of OME estimated. Percentage variation in OME incidence between the first non-pandemic year considered (group 1) and the pandemic period (group 3) was-63, 3%, with an absolute value decrease value of-305 cases. Similarly, comparing the second non-pandemic year (group 2) and the pandemic year (group 3) the percentage variation of OME incidence was-68, 1% with an absolute value of-305 cases decreased.

Conclusions: Our findings showed a lower incidence of OME during the pandemic period compared with 2 previous non pandemic years. The drastic restrictive anti-contagion measures taken by the Italian government to contain the spread of COVID-19 could have had a positive impact on the lower OME incidence during the last pandemic year.
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http://dx.doi.org/10.1007/s00405-021-06958-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8255053PMC
July 2021

Neck dissection and trans oral robotic surgery for oropharyngeal squamous cell carcinoma.

Auris Nasus Larynx 2021 Jun 3. Epub 2021 Jun 3.

Otolaryngology and Head-Neck Surgery Unit, Department of Head-Neck Surgeries, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy.

Objective: Trans Oral Robotic Surgery (TORS) is a modality in the management of oropharyngeal squamous cell carcinoma(OPSCC). This study was planned to determine whether Selective Neck Dissection (SND) is oncological safe procedure even in patients with lymph node metastases.

Methods: OPSCC patients were divided into Modified Radical Neck Dissection (MRND) and SND groups. The outcome measures were overall survival (OS), disease-free survival (DFS) and regional recurrence free survival (RRFS).

Results: Thirty-seven SNDs and 18 MRNDs were performed. Regional relapse rate was 6.1% in SND group whilst 18.8% in MRND group(p=0.19). The 5-year OS, DFS and RRFS rates' differences were not statistically significant between SND and MRND groups (p=0.40, p=0.42 and p=0.18, respectively). At multivariate analysis, advanced stage impacted the 5-year OS and DFS(HR=9.39, p<0.01 and HR=11.03, p=0.04).

Conclusions: The SND seems to be effective in a TORS framework. The indication should be accurately discussed by the multidisciplinary tumor board.
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http://dx.doi.org/10.1016/j.anl.2021.05.007DOI Listing
June 2021

Correction to: Endoscopic surgical treatment for rhinogenic contact point headache: systematic review and meta-analysis.

Eur Arch Otorhinolaryngol 2021 May 7. Epub 2021 May 7.

Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", ENT Section, ENT Department of University of Catania, Via Santa Sofia, 95100, Catania, Italy.

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http://dx.doi.org/10.1007/s00405-021-06844-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8102839PMC
May 2021

Surgical, clinical, and functional outcomes of transoral robotic surgery used in sleep surgery for obstructive sleep apnea syndrome: A systematic review and meta-analysis.

Head Neck 2021 07 16;43(7):2216-2239. Epub 2021 Apr 16.

Research Committee, Robotic Surgery Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France.

We investigated safety and efficacy of transoral robotic surgery (TORS) for base of tongue (BOT) reduction in obstructive sleep apnea syndrome (OSAS) patients. PubMed, Cochrane Library, and Scopus were searched. A meta-analysis was performed. Random effects models were used. Thirty-one cohorts met our criteria (1693 patients). The analysis was based mostly on retrospective studies. The summary estimate of the reduction of Apnea-Hypoxia Index (AHI) was 24.25 abnormal events per hour (95% CI: 21.69-26.81) and reduction of Epworth Sleepiness Scale (ESS) was 7.92 (95% CI: 6.50-9.34). The summary estimate of increase in lowest O saturation was 6.04% (95% CI: 3.05-9.03). The success rate of TORS BOT reduction, either alone or combined with other procedures, was 69% (95% CI: 64-79). The majority of studies reported low level of evidence but suggested that TORS BOT reduction may be a safe procedure associated with improvement of AHI, ESS, and lowest O saturation.
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http://dx.doi.org/10.1002/hed.26702DOI Listing
July 2021

Endoscopic surgical treatment for rhinogenic contact point headache: systematic review and meta-analysis.

Eur Arch Otorhinolaryngol 2021 Jun 6;278(6):1743-1753. Epub 2021 Mar 6.

Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", ENT Section, ENT Department of University of Catania, Via Santa Sofia, 95100, Catania, Italy.

Purpose: This meta-analysis study was designed to analyze endoscopic surgery's role in treating rhinogenic contact point headache.

Methods: We performed a comprehensive review of the last 20 years' English language regarding Rhinogenic contact point headache and endoscopic surgery. We included the analysis papers reporting post-operative outcomes through the Visual Analogue Scale or the Migraine Disability Assessment scale.

Results: We provided 18 articles for a total of 978 RCPH patients. While 777 (81.1%) subjects underwent functional nasal surgery for RCPH, 201 patients (20.9%) were medically treated. A significant decrease from the VAS score of 7.3 ± 1.5 to 2.7 ± 1.8 was recorded (p < 0.0001). At quantitative analysis on 660 patients (11 papers), surgical treatment demonstrated significantly better post-operative scores than medical (p < 0.0001).

Conclusion: At comparison, surgical treatment in patients with rhinogenic contact points exhibited significantly better values at short-term, medium-term, and long term follow up. Endoscopic surgery should be proposed as the choice method in approaching the symptomatic patient.
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http://dx.doi.org/10.1007/s00405-021-06724-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7936872PMC
June 2021

Barbed suture Extrusion and Exposure in palatoplasty for OSA: What does it mean?

Am J Otolaryngol 2021 Jul-Aug;42(4):102994. Epub 2021 Feb 20.

Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Via Carlo Forlanini, 34-47121 Forlì, Italy; Ear-Nose-Throat & Audiology Unit, University of Ferrara, 44121 Ferrara, Italy. Electronic address:

Purpose: Analyze Extrusion&Exposion (E&E), its implications in the functional, anatomical results and subjective discomfort in OSA patients treated with Barbed Reposition Pharyngoplasty (BRP).

Materials And Methods: 488 patients treated with BRP or multilevel TORS. Stratafix wire was used in 230 patients, V-Loc in 258. E&E, timing and localization evaluated at follow-up. Polygraphy used to assess the impact of E&E on functional results, PPOPS questionnaire used for subjective discomfort.

Results: E&E in the entire group was 18,4%, with significant difference between Stratafix and V-Loc wire (p = 0,002), but not between BRP alone and multilevel surgery (p = 0,68). 28,9% of extrusion happened within the first seven days, 76,7% between seven days and two months, 5,5% after two months. Symptomatic clinical profile has been seen in 62,2%, asymptomatic one in 37,8% of patients. 35,5% of E&E were localized in tonsillar bed, 46,7% in soft palate and 20% in other sites. Mean delta-AHI of E&E patients was -15,87 ± 16.82 compared with one of those who did not have E&E was -16.34 ± 22,77 (p = 0,38). Mean PPOPS of 183 patients analyzed was 12,32 ± 4,96. Mean PPOPS of extruded group was 12,94 ± 4,68 and 11,92 ± 5,11 in not extruded one (p = 0,166).

Conclusions: E&E are suture-type sensitive (V-Loc > Stratafix), reported more frequent when BRP is performed alone than BRP-TORS with no statistical significance. 76,7% of the E&E occur after patient discharge and within 2 months. About half of the E&E were localized in soft palate. There is no need to fear Extrusion&Exposition because it does not affect in a negative way subjective and PSG outcome.
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http://dx.doi.org/10.1016/j.amjoto.2021.102994DOI Listing
February 2021

Impedance-pH monitoring profile of patients with reflux and obstructive sleep apnea syndrome: A controlled study.

Clin Otolaryngol 2021 Jul 24;46(4):816-822. Epub 2021 May 24.

Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France.

Objective: To study the profile of patients with obstructive sleep apnoea syndrome (OSAS) and laryngopharyngeal reflux (LPR) at the hypopharyngeal-oesophageal multichannel intraluminal impedance-pH monitoring (HEMII-pH) and to compare their reflux findings with LPR patients without OSAS.

Design: Prospective controlled study.

Methods: Patients with LPR and OSAS were prospectively recruited from August 2019 to June 2020. The profile of hypopharyngeal reflux events (HREs) of patients was studied through a breakdown of the HEMII-pH findings over the 24 hours of testing. Reflux symptom score (RSS), and gastrointestinal and HEMII-pH outcomes were compared between LPR patients and patients with LPR and OSAS. Multivariate analysis was used to study the relationship between reflux data and the following sleep outcomes: Apnea Hypopnea Index, Epworth Sleepiness Scale (ESS) and paradoxical sleep data.

Results: A total of 89 patients completed the study. There were 45 patients with LPR and 44 subjects with both OSAS and LPR. The numbers of upright and daytime HREs and the otolaryngological RSS were significantly higher in patients with LPR compared with those with OSAS and LPR. There was a significant positive association between RSS quality-of-life score and ESS (P = .001). The occurrence of HREs in the evening was associated with higher ESS (P = .015). Patients with OSAS, LPR and GERD had higher number of nocturnal HREs compared with those without GERD (P = .001).

Conclusion: The presence of OSAS in LPR patients is associated with less severe HEMII-pH and ear, nose and throat symptoms. There may have different OSAS patient profiles according to the occurrence of GERD.
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http://dx.doi.org/10.1111/coa.13745DOI Listing
July 2021

Epidemiological, otolaryngological, olfactory and gustatory outcomes according to the severity of COVID-19: a study of 2579 patients.

Eur Arch Otorhinolaryngol 2021 Aug 16;278(8):2851-2859. Epub 2021 Jan 16.

COVID-19 Task Force of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France.

Objective: To investigate prevalence and epidemiological and clinical factors associated with olfactory dysfunction (OD) and gustatory dysfunction (GD) in COVID-19 patients according to the disease severity.

Study Design: Cross-sectional study.

Methods: A total of 2579 patients with a positive diagnosis of COVID-19 were identified between March 22 and June 3, 2020 from 18 European hospitals. Epidemiological and clinical data were extracted. Otolaryngological symptoms, including OD and GD, were collected through patient-reported outcome questionnaire and Sniffin'Sticks tests were carried out in a subset of patients.

Results: A total of 2579 patients were included, including 2166 mild (84.0%), 144 moderate (5.6%) and 269 severe-to-critical (10.4%) patients. Mild patients presented an otolaryngological picture of the disease with OD, GD, nasal obstruction, rhinorrhea and sore throat as the most prevalent symptoms. The prevalence of subjective OD and GD was 73.7 and 46.8%, and decreases with the severity of the disease. Females had higher prevalence of subjective OD and GD compared with males. Diabetes was associated with a higher risk to develop GD. Among the subset of patients who benefited from psychophysical olfactory evaluations, there were 75 anosmic, 43 hyposmic and 113 normosmic patients. The prevalence of anosmia significantly decreased with the severity of the disease. Anosmia or hyposmia were not associated with any nasal disorder, according to SNOT-22.

Conclusion: OD and GD are more prevalent in patients with mild COVID-19 compared with individuals with moderate, severe or critical diseases. Females might have a higher risk of developing OD and GD compared with males.
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http://dx.doi.org/10.1007/s00405-020-06548-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7811338PMC
August 2021

Oxidative Stress and Inflammation Biomarker Expression in Obstructive Sleep Apnea Patients.

J Clin Med 2021 Jan 13;10(2). Epub 2021 Jan 13.

Department of Sensory Organs, "Sapienza" University of Rome, 00100 Rome, Italy.

Obstructive Sleep Apnea Syndrome (OSAS) is a respiratory sleep disorder characterised by repeated episodes of partial or complete obstruction of the upper airway during the night. This obstruction usually occurs with a reduction (hypopnea) or complete cessation (apnea) of the airflow in the upper airways with the persistence of thoracic-diaphragmatic respiratory movements. During the hypopnea/apnea events, poor alveolar ventilation reduces the oxygen saturation in the arterial blood (SaO) and a gradual increase in the partial arterial pressure of carbon dioxide (PaCO). The direct consequence of the intermittent hypoxia is an oxidative imbalance, with reactive oxygen species production and the inflammatory cascade's activation with pro and anti-inflammatory cytokines growth. Tumour necrosis factors, inflammatory cytokines (IL2, IL4, IL6), lipid peroxidation, and cell-free DNA have been found to increase in OSAS patients. However, even though different risk-related markers have been described and analysed in the literature, it has not yet been clarified whether specified inflammatory bio-markers better correlates with OSAS diagnosis and its clinical evolution/comorbidities. We perform a scientific literature review to discuss inflammatory and oxidative stress biomarkers currently tested in OSAS patients and their correlation with the disease's severity and treatment.
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http://dx.doi.org/10.3390/jcm10020277DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7828672PMC
January 2021

Psychological Distress in a Sample of Adult Italian Patients Affected by Vocal Nodules and Muscle-Tension Dysphonia: Preliminary Results.

J Voice 2020 Dec 30. Epub 2020 Dec 30.

Division of Phoniatrics and Audiology, Department of Mental and Physical Health and Preventive Medicine, L. Vanvitelli University, Naples, Italy; Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France. Electronic address:

Objectives: To evaluate the correlation between voice disorders and psychological distress, in terms of anxiety, stress, and depression, in a sample of adult Italian patients and to compare our results with those obtained in a group of adult healthy controls matched by age, sex, geographic distribution, and occupation.

Methods: This prospective-controlled study included 100 adults with Vocal nodules (VN) and Muscle Tension Dysphonia (MTD1), aged between 18 and 65 years, as Experimental Group (EG) and 100 age-matched subjects without any voice disorders as a Control Group (CG). All patients in the EG underwent a phoniatric evaluation, including the administration of the Voice Handicap Index (VHI) and laryngeal examination. Both patients of EG and CG underwent a Psychological evaluation by means of standardized tests; Beck's Depression Inventory, State Anxiety Inventory (STAI 1-State Anxiety), Trait Anxiety Inventory (STAI 2- Trait Anxiety), and Perceived Stress Scale (PSS-10) were completed by patients. Fisher's exact test and chi-squared test were used to compare all categorical variables, whereas numerical variables were compared either with the nonparametric Mann-Whitney-Wilcoxon or with Kruskal Wallis test. General linear models were used to study continuous variables between patients and controls and between different groups within the sample.

Results: In the study group, the Physical domain (P score) of the VHI was more affected than the Emotional (E score) and Functional ones (F score) both in patients with MTD1 and VN; patients with VN presented a significant difference in P score, E score and VHI total score than patients with isolated MTD 1 (P < 0.005). Psychological assessment showed a significant difference (P < 0.005) between VN and MTD 1 regarding PSS-10 and STAI-1 scores. Low Beck's Depression Inventory scores were present in our sample without significant differences between patients with VN and those with MTD 1. Scores related to psychological distress in the EG were far superior to those obtained by the healthy CG, with markedly significant values especially for PSS-10 (P < 0.0001) and STAI 2 (P < 0.01). Finally, younger patients (18-35 years) with VN showed a highest risk of psychosocial distress.

Conclusion: the present study identified a high prevalence of psychological distress among patients with vocal disorders without any prior specific psychiatric diagnosis, especially in terms of anxiety and perceived stress. For this reason both these symptoms should be taken into consideration in the diagnostic, therapeutic, and follow-up process of patients with MTD1 and VN.
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http://dx.doi.org/10.1016/j.jvoice.2020.12.011DOI Listing
December 2020

Sleep medicine in otolaryngology units: an international survey.

Sleep Breath 2020 Nov 20. Epub 2020 Nov 20.

Unit of Otolaryngology, Hospital Morgagni Pierantoni, Via Carlo Forlanini 2, 47100, Forlì, Italy.

Purpose: No study to date has described the overall landscape of sleep disorders management and training in otolaryngology departments of different countries. The aim of our study was to investigate and compare settings, diagnostic and therapeutic approaches and training programmes.

Methods: An international online survey was developed with the collaboration of the YO-IFOS (Young Otolaryngologists-International Federation of Otorhinolaryngological Societies) to assess the current practice of otolaryngologists in the management of sleep disorders. The survey also included a session dedicated to training.

Results: A total of 126 otolaryngologists completed the survey. The larger part of responses was collected from Central/South America and Europe. The majority of responders from South/Central America (97%) declared to be certified as sleep specialist while 49% of Europeans stated the opposite. Of responders 83% perform a drug-induced sleep endoscopy (DISE) before planning a possible surgical intervention. Soft palate and base of tongue interventions were the most common procedure, respectively performed in 94% and 79% of the cases. Residents were allowed to perform soft palate surgery in 77% of the cases. Upper airway stimulation (26% vs 10%), trans-oral robotic surgery (36% vs 11%) and radiofrequency of the base of the tongue (58% vs 25%) were preferred more frequently by European responders. The highest caseloads of soft palate surgery and bi-maxillary advancement were registered in the academic institutions.

Conclusion: Significant concordance and few interesting divergences in diagnosis and treatment of sleep disorders were observed between nationalities and types of institution. Economic resources might have played a significant role in the therapeutic choice. Trainees' lack of exposure to certain interventions and to a sufficient caseload appeared to be the main burden to overcome.
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http://dx.doi.org/10.1007/s11325-020-02243-6DOI Listing
November 2020

Laryngopharyngeal reflux and head and neck cancers.

Am J Otolaryngol 2021 Jan - Feb;42(1):102815. Epub 2020 Oct 26.

Department of human Anatomy and Experimental Oncology, Mons School of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium; Department of Otorhinolaryngology-Head and Neck Surgery, Foch Hospital, UVSQ, Paris Saclay University, Paris, France.

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http://dx.doi.org/10.1016/j.amjoto.2020.102815DOI Listing
February 2021

Artificial Neural Network as a Tool to Predict Facial Nerve Palsy in Parotid Gland Surgery for Benign Tumors.

Med Sci (Basel) 2020 Oct 7;8(4). Epub 2020 Oct 7.

LEGIT Health, 48071 Bilbao, Spain.

(1) Background: Despite the increasing use of intraoperative facial nerve monitoring during parotid gland surgery or the improvement in the preoperative radiological assessment, facial nerve injury (FNI) continues to be the most feared complication; (2) Methods: patients who underwent parotid gland surgery for benign tumors between June 2010 and June 2019 were included in this study aiming to make a proof of concept about the reliability of an artificial neural networks (AAN) algorithm for prediction of FNI and compared with a multivariate linear regression (MLR); (3) Results: Concerning prediction accuracy and performance, the ANN achieved the highest sensitivity (86.53% vs 46.23%), specificity (95.67% vs 92.59%), PPV (87.28% vs 66.94%), NPV (95.68% vs 83.37%), ROC-AUC (0.960 vs 0.769) and accuracy (93.42 vs 80.42) than MLR; and (4) Conclusions: ANN prediction models can be useful for otolaryngologists-head and neck surgeons-and patients to provide evidence-based predictions about the risk of FNI. As an advantage, the possibility to develop a calculator using clinical, radiological and histological or cytological information can improve our ability to generate patients counselling before surgery.
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http://dx.doi.org/10.3390/medsci8040042DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7712376PMC
October 2020

Overview of different modified full-face snorkelling masks for intraoperative protection.

Acta Otorhinolaryngol Ital 2020 Oct 24;40(5):317-324. Epub 2020 Sep 24.

IRCCS Ospedale Policlinico San Martino, Unit of Otorhinolaryngology Head and Neck Surgery, Genoa, Italy.

Objective: The COVID-19 pandemic has caused significant impact on healthcare systems worldwide. The rate of infected healthcare workers is > 10% in Italy. Within this dramatic scenario, the development of new personal protective equipment (PPE) devices is mandatory. This study focuses on validation of modified full-face snorkel masks (MFFSM) as safe and protective equipment against SARS-CoV-2 infection during diagnostic and therapeutic procedures on the upper aerodigestive tract.

Methods: Five different MFFSM were tested during otolaryngological surgery and in anaesthesia procedures. Data were collected through an online survey to assess the feedback of operators. pO and pCO monitoring values during procedures were recorded in selected cases.

Results: All five MFFSM tested were easy to use and gave all operators a sound "feeling" of protection. All clinicians involved had common agreement regarding safety and the user-friendly format.

Conclusions: In the future, specific development of different type of masks for protection in the operating room, intensive care units and/or office will be possible as a joint venture between clinicians and developers. Goals for clinicians include better definition of needs and priorities, while developers can devote their expertise to produce devices that meet medical requirements.
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http://dx.doi.org/10.14639/0392-100X-N0841DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7726642PMC
October 2020

Olfactory function in patients with obstructive sleep apnea: a meta-analysis study.

Eur Arch Otorhinolaryngol 2021 Mar 10;278(3):883-891. Epub 2020 Sep 10.

Department of 'Organi di Senso', University "Sapienza", Viale dell'Università, 33, 00185, Rome, Italy.

Purpose: This meta-analysis study was designed to analyze the olfactory function in obstructive sleep apnea patients (OSA).

Methods: A comprehensive review of the English language literature regarding OSA patients and olfactory function/dysfunction was performed. The papers assessing olfactory dysfunction with Sniffin' Sticks test were taken into consideration.

Results: A total of 420 OSA patients were judged eligible for the study. The average TDI score was found to be 24.3 ± 5.6. The olfactory identification (OD), the olfactory discrimination (OD), and the olfactory threshold (OT) average values were calculated resulting 9.9 ± 2.1, 9.8 ± 1.5, and 5.3 ± 2, respectively. There were 161 healthy control subjects in this meta-analysis. The average TDI of the control group was 30.7 ± 6.0 showing a statistical difference with the group of OSA patients (p = 0.03). A linear correlation between Apnea-Hypopnea Index (AHI) increase and TDI decrease (R = 0.1, p = 0.05) was detected. Finally, the average values of TDI of 151 patients classified as mild-moderate OSA and 159 patients considered as severe OSA were calculated. The difference between these two groups resulted not statistically significant (p = 0.3).

Conclusion: The comparison between OSA patients and healthy subjects using Sniffin' Sticks test showed lower values of the various olfactory parameters. Although a linear correlation between AHI increase and olfactory dysfunction was observed, no statistical difference between mild-moderate and severe OSA patients in terms of the severity of olfactory dysfunction could be proved.
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http://dx.doi.org/10.1007/s00405-020-06316-wDOI Listing
March 2021

ACE2 & TMPRSS2 Expressions in Head & Neck Tissues: A Systematic Review.

Head Neck Pathol 2021 Mar 20;15(1):225-235. Epub 2020 Aug 20.

COVID-19 Task Force of the Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), Paris, France.

To review the data regarding the expression of angiotensin converting enzyme-2 (ACE2) and transmembrane protease serine-2 (TMPRSS2) in head and neck tissue. Scopus, Cochrane Library, Medrxiv, Google Scholar and PubMED/MEDLINE were searched by four independent investigators for studies investigating ACE2 or TMPRSS2 expressions in head and neck tissues. The following outcomes were considered: sample origin (animal versus human); detection method; anatomical location and cell types. PRISMA checklist and modified population, intervention, comparison, outcome, timing and setting (PICOTS) framework were used to perform the review. Of the 24 identified studies, 17 met our inclusion criteria. Thirteen studies were conducted during the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic. ACE2 and TMPRSS2 were expressed in oral, pharyngeal, sinusonasal human mucosa. The following cell types expressed ACE2: basal, apical, goblet, minor salivary, and endothelial cells. TMPRSS2 was found in goblet and apical respiratory cells. ACE2 and TMPRSS2 were found in the olfactory region, especially in sustentacular non-neural and neural stem cells. Animal studies suggested that ACE2 expression may vary regarding age. There was an important heterogeneity between studies in the methods used to detect ACE2 and TMPRSS2, leading to a potential identification bias. The SARS-CoV-2 receptors, ACE2 and TMPRSS2, are both expressed in many head and neck tissues, enabling the viral entry into the host organism.
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http://dx.doi.org/10.1007/s12105-020-01212-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7439628PMC
March 2021

Manipulation of Lateral Pharyngeal Wall Muscles in Sleep Surgery: A Review of the Literature.

Int J Environ Res Public Health 2020 07 23;17(15). Epub 2020 Jul 23.

Head and Neck Department, ENT & Oral Surgery Unit, G.B. Morgagni, L. Pierantoni Hospital, Forlì, FC 47100 ASL of Romagna, Italy.

Background: Obstructive sleep apnea syndrome (OSAS) occurs due to upper airway obstruction resulting from anatomical and functional abnormalities. Upper airway collapsibility, particularly those involving the lateral pharyngeal wall (LPW), is known to be one of the main factors contributing to the pathogenesis of OSAS, leading the authors of the present study to propose different strategies in order to stiffen the pharyngeal walls to try to restore normal airflow.

Methods: An exhaustive review of the English literature on lateral pharyngeal wall surgery for the treatment of OSAS was performed using the PubMed electronic database.

Results: The research was performed in April 2020 and yielded approximately 2000 articles. However, considering the inclusion criteria, only 17 studies were included in the present study.

Conclusions: The analyzed surgical techniques propose different parts of LPW on which to focus and a variable degree of invasivity. Despite the very promising results, no gold standard for the treatment of pharyngeal wall collapsibility has been proposed. However, thanks to progressive technological innovations and increasingly precise data analysis, the role of LPW surgery seems to be crucial in the treatment of OSAS patients.
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http://dx.doi.org/10.3390/ijerph17155315DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7432019PMC
July 2020

A structural equation model to examine the clinical features of mild-to-moderate COVID-19: A multicenter Italian study.

J Med Virol 2021 02 2;93(2):983-994. Epub 2020 Aug 2.

COVID-19 Task Force of the Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies, Paris, France.

The purpose of this study was to evaluate the clinical features of mild-to-moderate coronavirus disease 2019 (COVID-19) in a sample of Italian patients and to investigate the occurrence of smell and taste disorders. Infected individuals with suspected (clinical diagnosis) or laboratory-confirmed COVID-19 infection were recruited. Patients completed a survey-based questionnaire with the aim of assessing their epidemiological and clinical characteristics, general otorhinolaryngological symptoms, and smell and taste disorders. A total of 294 patients with mild-to-moderate COVID-19 completed the survey (147 females). The most prevalent general symptoms included fever, myalgia, cough, and headache. A total of 70.4% and 59.2% of patients reported smell and taste disorders, respectively. A significant association between the two above-mentioned disorders was found (rs: 0.412; P < .001). Smell disorders occurred before the other symptoms in 11.6% of patients and was not significantly associated with nasal obstruction or rhinorrhea. Interestingly, our statistical analysis did not show any significant difference, either for general symptoms or otorhinolaryngological features, between the clinical diagnosis group and the laboratory-confirmed diagnosis (polymerase chain reaction) group. The structural equation model confirmed significant standardized paths (P < .05) between general symptoms, comorbidities, and general otorhinolaryngological complaints in the absence of a significant correlation between these elements and smell and taste alterations. The prevalence of smell and taste disorders in mild-to-moderate Italian COVID-19 patients is significant both in suspected and laboratory-confirmed cases and reveals a strong correlation between these clinical signs regardless of the presence of general or otorhinolaryngological symptoms, such as nasal obstruction or rhinorrhea.
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http://dx.doi.org/10.1002/jmv.26354DOI Listing
February 2021

Trans oral robotic surgery versus definitive chemoradiotherapy for oropharyngeal cancer: 10-year institutional experience.

Oral Oncol 2020 11 10;110:104889. Epub 2020 Jul 10.

Otolaryngology and Head-Neck Surgery Unit, Department of Head-Neck Surgeries, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy; Otolaryngology Unit, University of Ferrara, Ferrara, Italy.

Objectives: Trans Oral Robotic Surgery (TORS) is a fascinating new technique that has proved to be a safe and feasible treatment of oropharyngeal squamous cell carcinoma (OPSCC). The aim of this study is to compare oncological outcomes of OPSCC-patients treated with either TORS (with or without adjuvant therapy) or definitive chemoradiation therapy (CRT).

Materials And Methods: This study involved 129 patients with OPSCC, treated with TORS or definitive CRT at our Department between 2008 and 2018. Clinicopathological characteristics, treatment specifications and oncological outcomes were evaluated retrospectively.

Results: Definitive CRT was administered in 69 patients (53,5%), while 60 (46,5%) were surgically treated with TORS alone or in combination with adjuvant therapy. Patients who underwent adjuvant therapy after TORS received a lower dosages of cisplatin and radiation than the CRT group (p < 0.01). There was no statistical difference in 5-year survival rate and in disease free interval between TORS and CRT groups. Albeit 5-year overall survival in the HPV-related tumours was better, the HPV status did not affect the rate of local and regional recurrence. Treatment groups (TORS vs. CRT) were not found affecting survivals on multivariate analysis. Tube feeding dependency rate was low between both groups (1.7% in TORS vs. 4.8% in CRT groups).

Conclusion: The modern management of OPSCC must be tailored to each patient. Although the definitive CRT remains a milestone, TORS is proving to be a valid and safe treatment option. The choice of single therapeutic strategy requires an evaluation by a multidisciplinary team.
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http://dx.doi.org/10.1016/j.oraloncology.2020.104889DOI Listing
November 2020

Features of Mild-to-Moderate COVID-19 Patients With Dysphonia.

J Voice 2020 Jun 4. Epub 2020 Jun 4.

COVID-19 Task Force of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS).; Department of Otorhinolaryngology-Head & Neck Surgery, Hospital Quironsalud Valencia, Spain.

Introduction: To explore the prevalence of dysphonia in European patients with mild-to-moderate COVID-19 and the clinical features of dysphonic patients.

Methods: The clinical and epidemiological data of 702 patients with mild-to-moderate COVID-19 were collected from 19 European Hospitals. The following data were extracted: age, sex, ethnicity, tobacco consumption, comorbidities, general, and otolaryngological symptoms. Dysphonia and otolaryngological symptoms were self-assessed through a 4-point scale. The prevalence of dysphonia, as part of the COVID-19 symptoms, was assessed. The outcomes were compared between dysphonic and nondysphonic patients. The association between dysphonia severity and outcomes was studied through Bayesian analysis.

Results: A total of 188 patients were dysphonic, accounting for 26.8% of cases. Females developed more frequently dysphonia than males (P = 0.022). The proportion of smokers was significantly higher in the dysphonic group (P = 0.042). The prevalence of the following symptoms was higher in dysphonic patients compared with nondysphonic patients: cough, chest pain, sticky sputum, arthralgia, diarrhea, headache, fatigue, nausea, and vomiting. The severity of dyspnea, dysphagia, ear pain, face pain, throat pain, and nasal obstruction was higher in dysphonic group compared with nondysphonic group. There were significant associations between the severity of dysphonia, dysphagia, and cough.

Conclusion: Dysphonia may be encountered in a quarter of patients with mild-to-moderate COVID-19 and should be considered as a symptom list of the infection. Dysphonic COVID-19 patients are more symptomatic than nondysphonic individuals. Future studies are needed to investigate the relevance of dysphonia in the COVID-19 clinical presentation.
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http://dx.doi.org/10.1016/j.jvoice.2020.05.012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7269945PMC
June 2020

Surgical, clinical and functional outcomes of transoral robotic surgery for supraglottic laryngeal cancers: A systematic review.

Oral Oncol 2020 Jun 10;109:104848. Epub 2020 Jun 10.

Robotic Surgery Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), France; Department of Otolaryngology-Head Neck Surgery, Foch Hospital, UFR Simone Veil, University Versailles Saint-Quentin-en Yvelines (University Paris Saclay), Paris, France.

Background: The aim of this systematic review is to shed light the current indications and outcomes of transoral robotic surgery (TORS) supraglottic laryngectomy (SGL) in patients with supraglottic laryngeal cancer.

Methods: PubMed, Scopus and Cochrane Library were searched by three independent otolaryngologists from the Young Otolaryngologists of IFOS for studies investigating the indications, effectiveness and safety of TORS SGL. Surgical, functional, and survival outcomes have been investigated. Inclusion/exclusion criteria; demographic data; and clinical outcome evaluation of papers were analyzed using PRISMA criteria.

Results: A total of 14 papers met our inclusion criteria, accounting for 422 patients (335 males & 87 females). The tumor location mainly consisted of epiglottis (55.4%), aryepglottic fold (31.2%), and ventricular band (5.1%). The following tumor stages were considered: cT1 (35.8%); cT2 (48.6%) and cT3 (13.9%). Feeding tube and percutaneous endoscopic gastrostomy were used in 62.5% and 8.82% of patients, respectively. The 24-month local & regional control rates ranged from 94.3% to 100% and 87.5% to 94.0%, respectively. The 2-year and 5-year overall survival rates ranged from 66.7% to 88.0% and 78.7% to 80.2%, respectively. There was an important heterogeneity between studies with regard to the inclusion/exclusion criteria, follow-up times, complications analysis; surgical and functional outcomes.

Conclusion: TORS SGL is an effective approach for treating patients with early stages supraglottic cancers. Future controlled studies are needed to compare functional and survival outcomes between TORS SGL and other surgical approaches. Recommendations have been provided for future studies for better inclusion of patients, analysis of complications and functional outcomes.
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http://dx.doi.org/10.1016/j.oraloncology.2020.104848DOI Listing
June 2020

Systematic review of international guidelines for tracheostomy in COVID-19 patients.

Oral Oncol 2020 09 5;108:104844. Epub 2020 Jun 5.

Task Force COVID-19 of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), France; Division of Otolaryngology - Head & Neck Surgery, Centre Hospitalier de l'Université de Montréal Montreal, Canada.

At this moment, the world lives under the SARS-CoV-2 outbreak pandemic. As Otolaryngologists - Head & Neck Surgeons, we need to perform and participate in examinations and procedures within the head and neck region and airway that carry a particularly high risk of exposure and infection because of aerosol and droplet contamination. One of those surgical procedures in demand at this moment is tracheostomy due the increasing ICU admissions. This review of international guidelines for tracheostomy in COVID-19 infected patients, aims to summarize in a systematic way the available recommendations: indications, timing, technique and safety measures for tracheostomy, from all over the world.
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http://dx.doi.org/10.1016/j.oraloncology.2020.104844DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7274612PMC
September 2020

Patient-Reported Outcome Questionnaires for the evaluation of olfactory and gustatory dysfunctions in COVID-19.

Eur Arch Otorhinolaryngol 2020 08 3;277(8):2393-2394. Epub 2020 Jun 3.

Department of Human Anatomy and Experimental Oncology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium.

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http://dx.doi.org/10.1007/s00405-020-06083-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7268976PMC
August 2020

Minimizing Contagion Risks of COVID-19 During Transoral Robotic Surgery.

Laryngoscope 2020 11 29;130(11):2593-2594. Epub 2020 Jul 29.

Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy.

In this communication, we would like to share our experience in managing TORS patients during COVID-19 pandemic. Laryngoscope, 130:2593-2594, 2020.
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http://dx.doi.org/10.1002/lary.28847DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7283799PMC
November 2020

Transoral robotic submandibular sialadenectomy: how and when.

Gland Surg 2020 Apr;9(2):423-429

Head and Neck Department, ENT & Oral Surgery Unit, G.B. Morgagni-L. Pierantoni Hospital of Forlì, Forlì, Italy.

Traditional removal of the submandibular gland is done through a transcervical approach; new proposals have come into the scientific limelight such as endoscopy-assisted transcervical sialadenectomy or (robot-assisted) submandibular sialadenectomy through a postauricular facelift transcervical approach. Transoral submandibular sialadenectomy has been described in the past, but with the advent of transoral robotic surgery, the proposal of removing the submandibular gland from the oral floor is gaining strength. A transoral robotic submandibular sialadenectomy by the Si Da Vinci Surgical Robot was performed in a 68-years-old female patient under general anaesthesia. The transoral robotic procedure was successful with no major postoperative complications. A mild tingling of the tip of the tongue was described by the patient 3 months after. The surgical time took 110 minutes. No residual gland was observed at ultrasonography. The transoral robotic submandibular sialadenectomy seems to be, with selective indication based on clinical and radiological assessment, a viable and safe alternative to traditional management in patients who refuse a cervical scar and the risk of paralysis of the facial nerve.
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http://dx.doi.org/10.21037/gs.2020.02.04DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7225484PMC
April 2020
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